Scabies Crustosa in a Patient with Insufficientia Renalis-Case Report.

Background: SScabies is caused by the parasite Sarcoptes scabiei. The disease was first described in ancient Greece, while Ferdinand Von Hebra described the stages of development of the arthropodite from the egg to larvae and the adult form of sarcoptosis. The final stage is characterized by the travel of the female parasite and the laying of eggs in stratum corneum and followed by the death of the causer. The main characteristic symptom of scabies is relentless pruritus which is a result of such an infestation inside the skin, as the body reacts to parasites and their excretions, where mites burrow and lay eggs. Methods: Here we present the 85-year-old patient with scabies crustosa, latent diabetes and renal insufficiency. Results: Persistent pruritus and scabies rash, where large numbers of mites were detected, was left untreated and further progressed into sores due to scratching. Weakened immunity and chronic illness in the patient resulted in a more severe form of the disease which was diagnosed as scabies crustosa. After treatment with a supplemented antiscabiotic regimen, the patient remained symptom free. Conclusion: Large population movements, one of the main factors of spread and frequent incidence of scabies, contact with the sick, hygiene means, exchange of wardrobes, sharing bed with the sick, schools, preschools, old-age-care institutions and hospitals, enable spread of the disease. In addition, severe types of scabies that form thick crusts on the skin and present with pruritus as a symptom should be considered in immunocompromised and elderly patients with renal insufficiency where pruritus is also prevalent.

Activation of Herpes Simplex Infection after Tattoo.

Tattooing is a procedure where ink is applied to an area of the skin, mostly intraepidermally (1). This procedure is carried out mainly for aesthetic purposes. Lately, it has been used as a corrective medical procedure following amputation of mammilla. The procedure is aggressive (2), and the fact that skin is punctured many times with the same needle which cannot be fully sterilized may cause infection of the treated area with bacterial, fungal, or viral agents that may lead to health consequences manifesting in the form of verrucae vulgaris, molluscum contagiosum, and herpes simplex. On the other hand, complications such as granulomas, allergic reactions, Koebner phenomenon, lupus erythematosus, psoriasis, lichen ruber planus, hepatitis C, and HIV infections should also be considered as potential consequences of tattooing (3-7). Even systemic reactions have been reported. Herein we describe a case of herpes infection activation after tattooing. Herein we present the case of a 46-year-old woman, employed in the medical sector, with a two-day history of herpes simplex in the labial area that manifested following application of a cosmetic tattoo meant to outline the lips (Figure 1). Two days after tattoo application, the vesicular lesions appeared along the area that was filled with ink, followed by sub-febrile temperature and fever and a subjective feeling of itching initially, followed by burning sensation and pain. The skin signs located on erythematous base were mainly grouped vesicles with sharply demarcated borders. Regional lymphatic nodes, mainly retro auricular, were enlarged. Within 48 hours, the patient was treated with acyclovir tablets in a dose of 800 mg three times a day and an antipyretic. Acyclovir ointment was administered during the first two days, as well as tetracycline ointment after the second day of the eruption. On the fifth day, we observed regression of the skin changes (Figure 2), and complete healing was achieved after one week. We assessed the medical history of the patient, which revealed the following: hypothyreosis due to lobectomy performed for the treatment of toxic adenoma. The patient was under substitutional therapy with 75 mg levothyroxine. The patient had herpes simplex before, and this was the second herpetic eruption. Herpes simplex is caused by a herpes simplex virus (HSV) type-1 infection that is transmitted through droplets of saliva or direct contact with the affected area, for example during kissing (8-10). Histology reveals intraepidermal blisters, degeneration in epidermal cells at the base of the vesicle, and multilocular eosinophilic inclusional bodies inside cells. Infection is usually more pronounced in the initial phase of disease, where the symptoms are also more intense. Activation of the infection occurs when the body undergoes a decrease in immunity (1), in situations of extensive exposure to the sun, and also in some other circumstances, such as the application of a tattoo as described herein. Tattooing can inoculate the virus or trigger the activation of the herpes virus and other viruses (1,8-10). Tattooing, apart from bringing social stigma in some cases, which is one of the major issues for persons who undergo the procedure, may also cause injuries, contact dermatitis, foreign body granuloma, infections, and allergic reactions including anaphylaxis. Herpes simplex infections are also possible, either by inoculation or reactivation of the HSV. Except in situations where the tattoo is performed for medicinal purposes, tattooing is not a procedure that is supported by dermatologists. Furthermore, tattooing also causes a number of side effects. Allergic reactions (3,4), anaphylactic shock, foreign body granuloma, lichen ruber planus (5), granuloma pyogenes (5), verruca vulgaris, molluscum contagiosum, herpes simplex, and some other bacterial and viral infections.

Erythema exsudativum multiforme induced by a taurine-containing energy drink.

Erythema exsudativum multiforme is an immunologically mediated skin condition caused by viruses, bacteria, food, and drugs. There are different forms, and depending on the severity of the disease there is a major and minor form. Whereas the minor form passes without consequences, the major form and Stevens-Johnson syndrome affect the mucosa and may result in death. The disease affects all age groups but is more often observed in young individuals. Typical signs of the disease are skin lesions termed herpes iris. Taurine is an organic compound used in energy drinks and food that can cause many forms of hypersensitivity reactions, and one of these is erythema exsudativum multiforme. As consumption of energy drinks containing taurine increases, the problem of an increase in cases presenting with various forms of hypersensitivity reactions should be considered. Here we present the case of a 19-year-old man with erythema exsudativum multiforme caused by a drink containing taurine. We excluded all other factors that may have caused erythema multiforme and the patient was hospitalized, having been referred to us for the second time presenting with the same problem caused twice by the same drink.

Congenital nephrotic syndrome.

The aim of this case is to present a case of a two month old female with congenital nephritic syndrome, which is very rare. On admission, the baby showed marked edema and distended abdomen. She was diagnosed and treated with daily albumin infusions, antibiotics, diuretic, gamma globulin replacement, ACEI and NSAIDs. Parents were informed about the nature of the disease, prognosis, and advised for further medical care in a more advanced kidney transplantation centre. This was the first treatment of this condition in the Pediatric Clinic in Kosovo and it presented a challenge for us.